<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">

<?php include("header.php"); ?>

<body>

<?php include("subheader.php"); ?>

<div id="contentbg">
  <div id="contentblank">
    <div id="content">



      <?php include("contentleftRecuperacion.php");?>



      <div id="contentmid">

        <!-- CONTENIDO DE LA PAGINA AQUI -->






        <div class="midheading">
                      <h2>Solicitar Donacion</h2>
        </div>

        <div id="projectbg2">

             <?php if(isset($_SESSION['k_username'])) { ?>
            <form action="SolicitarDonacion2.php" method ="post">
		<pre><div style="font-family:Arial; color: #853008">
Cantidad *:                                 <input name="cant" type="text"  id="textfield"/>

Tipo de Donacion *:                  <select name="tipo">
     												 <option value="0">Seleccione...</option>
                                                     <option value="1">Vestimenta</option>
                                                     <option value="2">Alimento</option>
                                                     <option value="3">Aseo Personal</option>
                                                     <option value="4">Medicamentos</option>
                                                     <option value="5">Monetario</option>
                                                     <option value="6">Agua</option>
                                                     </select>


Estado *:                                     <select name="zona">
                                                     <option value="0">Seleccione...</option>
                                                     <option value="Amazonas">Amazonas</option>
                                                     <option value="Anzoategui">Anzoategui</option>
                                                     <option value="Apure">Apure</option>
                                                     <option value="Aragua">Aragua</option>
                                                     <option value="Barinas">Barinas</option>
                                                     <option value="Bolivar">Bolivar</option>
                                                     <option value="Carabobo">Carabobo</option>
                                                     <option value="Cojedes">Cojedes</option>
                                                     <option value="Delta Amacuro">Delta Amacuro</option>
                                                     <option value="Falcon">Falcon</option>
                                                     <option value="Guarico">Guarico</option>
                                                     <option value="Lara">Lara</option>
                                                     <option value="Merida">Merida</option>
                                                     <option value="Miranda">Miranda</option>
                                                     <option value="Monagas">Monagas</option>
                                                     <option value="Nueva Esparta">Nueva Esparta</option>
                                                     <option value="Portuguesa">Portuguesa</option>
                                                     <option value="Sucre">Sucre</option>
                                                     <option value="Tachira">Tachira</option>
                                                     <option value="Trujillo">Trujillo</option>
                                                     <option value="Vargas">Vargas</option>
                                                     <option value="Yaracuy">Yaracuy</option>
                                                     <option value="Zulia">Zulia</option>
                                                     <option value="Distrito Capital">Distrito Capital</option>
                                                     </select>

Descripcion:
                                                    <textarea name="desc" cols="20" rows="10"></textarea>



                                                      <input type="submit" name = "submit" value="Enviar"/>




 			</div>
       </pre>

            </form>

            <?php } else {



                echo "<div align=\"center\"><br><br><br><br><br><br><br><br><br>Debe ser un Centro de Acopio registrado para acceder a esta pagina</div>";


            } ?>

        </div>




		<!-- CONTENIDO DE LA PAGINA HASTA AQUI -->
		</div>

      <?php include("contentright.php");?>




    </div>
  </div>
</div>


<?php include("footer.php");?>


</body>
</html>